tbuckley/cabot-search huggingface dataset:
Abstract 13143: Genetic Testing Referral Patterns Among Women With Peripartum Cardiomyopathy
Authors: Elizabeth Packard, Nosheen Reza, Anjali Owens, Zoltan Arany, Jennifer Lewey
Journal: Circulation (2022)

Introduction: The genetic architecture of peripartum cardiomyopathy (PPCM) and dilated cardiomyopathy (DCM) overlap, and 15% of patients with PPCM have a disease-causing variant in a DCM-associated gene. Despite the impact of genetics on cascade screening and risk stratification, there are no recommendations for genetic testing in PPCM. We aimed to quantify the percentage of individuals with PPCM referred for genetic testing and to identify factors that may impact the likelihood of referral for genetic testing. Methods : We conducted a retrospective cohort study of 205 patients diagnosed with PPCM from 1986-2018 within the University of Pennsylvania Health System who had outpatient follow-up. We determined the referral rate for genetic testing and examined differences in referral based on race, timing of PPCM diagnosis, hypertensive disorders of pregnancy (HDP), NYHA class at diagnosis, LVEF at diagnosis, family history, recurrent PPCM, and referral to a heart failure specialist. We compared continuous variables using the Student t test and categorical variables using Pearson’s chi-square test. Results : Of 205 patients with PPCM, 23 (11%) were referred for genetic testing. Women referred for genetic testing were more likely to have HDP (61% vs. 37%, p=0.03), LVEF &lt;30% at diagnosis (65% vs. 42%, p=0.04), recurrent PPCM (17% vs. 5%, p=0.04), a first-degree family member with heart failure or cardiomyopathy (70% vs. 17%, p&lt;0.001), and any documented family history at the first cardiology visit (78% vs. 54%, p=0.03). Of those referred, 17 (74%) underwent genetic counseling, and 12 (52%) completed genetic testing. Two patients (17%) had a pathogenic or likely pathogenic variant in TTN and were recommended for cascade screening, and 9 (75%) had variants of unknown significance which were predominately missense variants. Conclusions : A minority of women with PPCM are referred for genetic testing. Referral is largely driven by family history, which may lead to under-diagnosis of pathogenic mutations. Increasing referral rates may improve the detection of pathogenic mutations which may impact the care provided to affected women and their families.
Abstract 13328: Mitral Annular Calcification and All-Cause, Cardiovascular, and Non-Cardiovascular Mortality in a Multiracial Cohort: The Multi-Ethnic Study of Atherosclerosis
Authors: Ellen Boakye, Gregg S Pressman, Zeina A Dardari, Kunal Jha, Moyses Szklo, Matthew Budoff, Khurram Nasir, Michael J Blaha, Ebenezer Oni
Journal: Circulation (2022)

Introduction: Mitral annular calcification (MAC) may be a potential marker of biological aging. However, the relative association of MAC with mortality, including all-cause, cardiovascular, and non-cardiovascular mortality in a multiracial cohort, is not well studied. Methods: We used data from 6814 men and women (mean age 62.2 ±10.2 years; 12% Chinese, 38% White, 22% Hispanic, and 28% African American) without CVD at baseline in the Multi-Ethnic Study of Atherosclerosis. MAC (absent/present and &lt;100/≥100 AU) was assessed with non-contrast cardiac computed tomography at baseline. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we evaluated the association of MAC with all-cause, and cardiovascular and non-cardiovascular mortality, respectively. Results: The prevalence of MAC was 9.5% and was higher in women (10.7%) than men (8.0%). Compared to persons without MAC, those with MAC &gt; 0 had higher incidence rate of all-cause (13.6 vs. 41.2 per 1000 person-years), cardiovascular (3.1 vs. 11.0 per 1000 person-years), and non-cardiovascular mortality (9.9 vs. 28.7 per 1000 person-years) over a mean follow-up of 14.4 ± 3.7 years. Persons with MAC &gt; 0 had significantly higher multivariable-adjusted risk of all-cause (Hazard Ratio [HR]: 1.51; 95%CI: 1.32 - 1.72), cardiovascular (SHR: 1.46; 95%CI: 1.09 - 1.95), and non-cardiovascular mortality (SHR: 1.37; 95%CI: 1.16 - 1.61), compared to those without MAC. Similarly, compared to MAC &lt;100 AU, MAC ≥100 was associated with a 1.82 (1.53 - 2.15), 1.55 (1.07 - 2.25), and 1.62 (1.30 - 2.01)-fold increased hazard of all-cause, cardiovascular, and non-cardiovascular mortality, respectively ( Figure ). Conclusions: In this multiracial cohort, MAC was associated with all-cause, cardiovascular, and non-cardiovascular mortality. Thus, MAC may be a marker not only for atherosclerotic burden but also for other metabolic and inflammatory factors that increase the risk of death from other causes.
Abstract 13440: Effect of Pemvidutide (ALT-801), a Novel GLP-1/Glucagon Dual Receptor Agonist, on Pathogenic Lipid Mediators
Authors: Jorge Plutzky, M. Scott S Harris, Cristina Alonso, John Suschak, Mustafa Noor, Pablo Ortiz, Bertrand Georges, Daniel J Rader, Scot S Roberts, Sarah K Browne
Journal: Circulation (2022)

Introduction: GLP-1 based agents are receiving intense attention for their potential to decrease CV risk. Pemvidutide is a unique, balanced GLP-1/glucagon dual receptor agonist (RA) combining the anorectic effects of GLP-1 RA with the increased energy expenditure and lipid-lowering effects of glucagon RA. In a 12-week double-blind clinical trial in subjects with overweight/obesity, pemvidutide reduced body weight by 10.3% and significantly decreased total cholesterol (-28%), LDL-C (-26%), and triglycerides (-38%). Here we leveraged lipidomics to investigate the effects of pemvidutide on other lipid mediators implicated in atherosclerosis and metabolic syndrome (MetS). Methods: Plasma lipidomic mass spectrometry was performed on baseline and Day 84 samples from 34 subjects receiving 1.2 mg, 1.8 mg, or 2.4 mg pemvidutide, or placebo, subcutaneously weekly. Results: Pemvidutide achieved significant dose-dependent reductions from baseline across multiple bioactive lipid classes (Figure), including pro-atherogenic lysophosphatidylcholines (Lyso-PC, a major oxidized LDL component), and lipotoxic sphingolipids, including sphingomyelins and ceramides, across the 12 weeks of treatment. Significant decreases were also observed in ether-linked alkyl phosphatidylcholine (PC) and phosphatidyl-ethanolamine (PE) glycerophospholipids, and in shorter chain, more saturated glycerolipids associated with insulin resistance were also observed. Conclusions: Pemvidutide induced pronounced, rapid weight loss with substantial decreases in lipotoxic and pro-atherogenic lipid species. These findings support pemvidutide’s potential benefit on obesity-associated CV co-morbidities, including atherosclerosis and MetS.
Abstract 13346: Long Term, Synergistic Benefit of Transmyocardial Laser Revascularization and Platelet Rich Plasma - Significant Improvement of Global Longitudinal Strain in Coronary Artery Bypass Graft Patients
Authors: Zain Khalpey, Usman Aslam, Jessa Deckwa
Journal: Circulation (2022)

Introduction: Transmyocardial revascularization (TMR) is a procedure designed to treat patients with end-stage coronary artery disease (CAD). TMR creates myocardial micropores which undergo endothelialization and redistribute ischemic stress, thereby improving regional wall motion. Autologous platelet rich plasma (PRP) growth factors contribute to endothelialization and neovascularization. In this study, we evaluate the effectiveness of TMR combined with PRP to improve cardiac function in patients undergoing CABG using echocardiograms. Methods: A single-center, single surgeon retrospective analysis of CABG patients was performed (2019-2021). Patients in the TMR group had ten channels (7 Watts/channel) created in the infero-lateral wall of the left ventricle (LV) and those in the PRP group had autologous PRP extract injected(1ml, without calcium) in the same area. In patients treated with both TMR and PRP, ten channels were made in the inferolateral LV with PRP extract injected in the peri-TMR zone, 5mm adjacent to the channels. Post-operative ejection fraction (EF) and global longitudinal strain (GLS) were measured using speckle tracking up to one year. Results: Fifty-two patients (71% men, mean age 66y ±9.04y) were enrolled in the study and randomized to four experimental groups: CABG only (n=16); CABG/TMR (n=17); CABG/PRP (n=10); and CABG/TMR/PRP (n=9). At one-year follow-up, patients treated with both TMR and PRP had a significant improvement in average GLS (-15.96, p= 0.02) compared to TMR alone (-13.78, p= 0.26) and PRP alone (-15.79, p= 0.08). Patients treated with TMR and PRP also had a significant rise in post-operative EF (57.78%, SD +/- 6.18) compared to TMR alone (55.0%, SD +/- 6.85) and PRP alone (49.5%, SD +/- 11.65). Conclusions: TMR with PRP extract treatment at the time of CABG confers a significant one year improvement in cardiac function as measured by LVEF and GLS. These outcome metrics highlight cardiac remodeling and can mitigate the incidence of heart failure readmissions. With further prospective trials and longer follow-up periods, concomitant adjunctive TMR with PRP extract therapy at time of CABG may have durable and significant cardiac scar remodeling benefits leading to heart recovery in CABG patients.
Abstract 13573: Machine Learning to Identify Predictors of Lapses in a Beginners’ Exercise Program for Adults With Type 1 Diabetes
Authors: Rajat Doshi, Jason Liu, Sangchoon Jeon, Michael S Businelle, Emily T Hebert, Laura Nally, Matthew Stults-Kolehmainen, Lisa Fucito, Stuart Weinzimer, Mark Gerstein, Garrett Ash, Matthew Stults-Kolehmainen
Journal: Circulation (2022)

Introduction: People with type 1 diabetes (T1D) are advised to perform the amounts of exercise recommended for the general population but encounter additional barriers including blood glucose management and fear of hypoglycemia. We previously reported that 20 adults with T1D (55% female) that received personalized biosensor feedback, completed mood diaries, and accessed on-demand instructional videos for 10 weeks increased their exercise to levels that partially met recommendations (median 64 [IQR 20, 129] minutes/week). Herein we use machine learning methods to predict the occurrence of lapses (i.e., days when exercise was not performed). Methods: We modeled exercise lapses using 95 possible predictive features derived from the prior 7 days of: 1) continuous glucose monitor summary statistics (mean, variability, time &gt;180, 70-180, &lt;70 mg/dL) for each daytime, nighttime, and 24hr window; 2) negative glycemic experiences around exercise (hypo/hyperglycemia, excessive insulin-on-board, nocturnal hypoglycemia); 3) subjective fear of hypoglycemia entered each morning and evening; 4) subjective sleep quality; and 5) illness. We created three different models using Random Forest (RF), Support Vector Machine (SVM), and Deep Neural Network (DNN) with an 80:20 train-test split of the data (960 training &amp; 240 testing days). We used upsampling to balance the data between lapse and non-lapse days. Results: First, the SVM achieved 71.2% with the most important features being sickness, mean nighttime glucose levels, 24hr time &lt;70 mg/dL, and variability. Next, the RF achieved a higher accuracy (74.1%) with the most important feature being sleep (significance 0.16) followed by the negative glycemic experiences around exercise (0.09 - 0.14). The most accurate model was the DNN with 5-fold cross-validation (75.2% accuracy, 77.5% precision, 71.4% sensitivity). Conclusion: Machine learning models that leverage biosensor, mood, and sleep data may be used to predict exercise lapses for adults with T1D, which could inform just-in-time motivational prompts in future mobile exercise interventions. Model performance might be improved by including subject-level features (e.g., demographics) and adding a sleep biosensor to complement sleep ratings.
Abstract 14458: It Takes Three to Tango: A Case of Occult <i>Streptococcus Gordonii</i> Infectious Endocarditis After Dental Cleaning Identified by History, Multi-Modal Imaging, and a Multi-Disciplinary Effort
Authors: Annie J Tsay, Michael C Gavin, Neil Datta
Journal: Circulation (2022)

Introduction: We present a case of a 65 year-old man with severe aortic regurgitation requiring a stented 23mm Edwards bioprosthetic aortic valve (BioAVR), who presented with 3-months of fevers and fatigue found to have Streptococcus gordonii ( S. gordonii ) infectious endocarditis (IE). He underwent dental cleaning 3-months prior sans prophylactic antibiotics. An echocardiogram on admission revealed increased peak/mean systolic gradients across the BioAVR to 46/26mmHg compared to gradients one year prior (32/19mmHg). Initially, a vegetation was not visualized by transthoracic echocardiogram (TTE) despite radiographic evidence of multi-organ emboli. Serial TTEs and transesophageal echocardiograms (TEEs) were performed due to persistent symptoms. Eventually, a new vegetation was visualized by TEE. A team effort involving cardiology, infectious disease, neurology, and cardiac surgery was required for management. Revision of the BioAVR was not pursued due to resolution of the vegetation. The patient was discharged after a prolonged hospitalization with recommendations to take amoxicillin 2g prior to future dental work. Results: Figure 1. A new 0.5cm vegetation visualized by TEE (A) with enlargement to 0.8cm (B), followed by a healed vegetation (C), and resolution 7-months later. Conclusions: S. gordonii has historically been a rare cause of IE therefore requiring a high clinical suspicion for diagnosis. Approximately 8% of IE cases are caused by streptococci. However, a recent study in Denmark on streptococci IE implicated S. gordonii in 44.2% of IE cases . S. gordonii is a gram-positive cocci found in oral flora known to cause subacute bacterial endocarditis. Our case highlights the importance of detailed history-taking to identify sources of infection, serial multi-modal imaging evaluation despite initial negative findings particularly with persistent clinical symptoms, and a multidisciplinary approach to IE cases due to multi-organ involvement.
Abstract 15384: Regional Trends in Watchman Device Placement in United States, Insight From National Inpatient Sample
Authors: Muhammad Z Khan, Muhammad Munir, yasar sattar, Karthik Gonuguntla, Muchi Ditah Chobufo, Anas Alharbi, Paulina Skaff, Muhammad U Khan, sudarshan balla
Journal: Circulation (2022)

Introduction: Watchman Implant is a minimally invasive procedure designed to reduce the risk of strokes that originate in the left atrial appendage in patients who cannot receive anticoagulation. Recently, the device is widely adopted in United States(US). Hypothesis: Significant variability exists in watchman device implantation across US. Methods: National Inpatient sample was used from year 2015-2019. ICD9 &amp; ICD-10 codes were used for data extraction. US population was divided into four regions. Northeast, Midwest, South and West. Mortality and major complications were adjusted for age, sex, race and standard comorbid conditions using logistic regression analysis. Major complication was composite of cardiac arrest, ischemic stroke, hemorrhagic stroke, TIA, arterial embolism, myocardial infarction, major bleeding, pericardial effusion requiring intervention and peripheral vascular complications. Results: Total of 62,980 patients were identified (Figure1). There has been gradual increase trend in watchman implants over the years. Median age was 77(71-82) yrs. Mortality was lowest in Midwest (Figure 2), while Major complications were lowest West region (Figure 3). Conclusions: Significant variability exists in outcomes across different regions of US. Further studies are needed to determine the significance of these findings.
Abstract 14598: Relationship of Ambulatory Blood Pressure Profiles on Progression of Aortic Atheroma in Patients With Stroke
Authors: Sung-Hee Shin, Ji Hun Jang, Hee-Kwon Park
Journal: Circulation (2022)

Introduction: Aortic atherosclerotic burden is known to be associated with an increased risk of ischemic stroke. However, longitudinal data and the risk factors about aortic plaque progression are limited. Hypothesis: We hypothesized that ambulatory blood pressure (BP) variables would play a role in progression of aortic atheroma over 2 years in patients with stroke Methods: 115 patients with who underwent serial transesophageal echocardiography (TEE) over 2 years were enrolled. Aortic atheroma was graded as mild (2-3mm), moderate (3-5 mm), severe (&gt;5mm), or complex (ulceration and/or mobile component) using TEE. Progression of aortic atheroma was defined as an increase of maximal plaque thickness by ≥1 grade. Ambulatory BP monitoring (ABPM) was performed when BP was stabilized. The association between ABPM variables and aortic atheroma progression was assessed. Results: During the median follow-up of 25.0 months, 10 (8.7%) were regressed, 13 (11.3%) were progressed, and 92 (80.0%) remained unchanged. Female had more progression of aortic atheroma (p=0.007). However, baseline LDL cholesterol, change of LDL cholesterol, intensity of statin and baseline plaque thickness were not significantly associated with change of aortic plaque. Regarding ABPM variables, systolic ABPM variables including 24 hour, daytime and nighttime mean systolic BP were associated with progression of aortic atheroma, whereas diastolic BP variables were not associated with change of aortic atherosclerosis. 24 hour, daytime and nighttime mean systolic BP were significantly related to plaque progression even after adjusting for clinical parameters (p=0.007 for 24 hour and daytime SBP, p=0.003 for nighttime SBP). Conclusions: Systolic BP variables were associated with progression of aortic atheroma in patients with stroke, which suggests systolic BP control can be a key to suppress progression of aortic plaques.
Abstract 12828: Association of Neighborhood Characteristics With Outcomes in Patients With Atrial Fibrillation in a Large Midwest Community
Authors: Alanna M Chamberlain, Alvaro Alonso, Konstantinos Siontis, Peter A Noseworthy, Sheila M Manemann, Susan Weston, Jill Killian, Euijung Ryu, Veronique L Roger
Journal: Circulation (2022)

Background: The communities in which people live affect their health. We aimed to determine whether neighborhood characteristics are associated with outcomes in patients with atrial fibrillation (AF) in a Midwest community. Methods: Patients with incident AF from 2013-2017 from a 27-county region who survived &gt;90 days after their diagnosis were identified (N=14,725). Patient addresses were linked to publicly-available data on population density (rural-urban commuting area; RUCA) and neighborhood socioeconomic status (area deprivation index; ADI). Patients were followed for ischemic stroke or transient ischemic attack (TIA), heart failure (HF), dementia/delirium, and all-cause death through 2021. Cox regression determined risk of outcomes by RUCA category (urban, micropolitan, small rural, isolated) and ADI quartile after adjustment for age, sex, race/ethnicity, and CHA2DS2-VASc score. Results: After excluding persons missing race/ethnicity (n=46), RUCA (n=1,465), and ADI (n=1,640), 13,233 patients with AF (mean age 73.8 years, 57% men) remained. After a median follow-up of 4.7 years, 5,989 patients died; 582 experienced a stroke/TIA, 4,122 (of 9,156 patients at risk) developed HF, and 1,758 (of 12,154 patients at risk) developed dementia/delirium. Persons living in isolated areas (HR 1.14, 95% CI 1.05-1.24) and the highest ADI quartile (HR 1.59, 95% CI 1.37-1.85) experienced the greatest risk of death (Figure). A trend toward an increased risk of HF was observed for the 2 highest ADI quartiles (p-trend &lt;0.01), although the estimates did not reach statistical significance. The risk of other outcomes did not differ by RUCA or ADI category. Conclusion: Patients with AF residing in isolated areas and neighborhoods with greater area deprivation experience increased risks of death. Additional research is needed to better understand how neighborhood characteristics influence treatment, co-morbid conditions, and other outcomes in patients with AF.
Abstract 15237: Alterations in the Human Mitral Valve in-vivo Functional State in Mitraclip Repair
Authors: Natalie T Simonian, Hao Liu, Sneha Vakamudi, Mark J Pirwitz, Joseph H Gorman, Robert C Gorman, Michael S Sacks
Journal: Circulation (2022)

Introduction: The MitraClip for treatment of mitral regurgitation (MR) is a generally safe and effective procedure. However, recent clinical trials have reported contradictory outcomes, and long-term efficacy remains almost completely unknown. Therefore, there is an urgent need for quantitative, patient-specific treatment optimization grounded on a robust understanding of the functional consequences of the MitraClip repair procedure on each patient-specific mitral valve (MV). Methods: Real-time 3D echocardiography images of ten MR patients’ MVs were acquired during the MitraClip procedure. These images were analyzed using our validated noninvasive strain estimation method to compute the pre-operative leaflet strain fields in the circumferential and radial directions. For the post-operative analysis, 3D MitraClip models were implemented in the corresponding size and number in the simulation to directly grasp the MV leaflets at echo-dictated positions. Results: The MV pre-surgical states were highly variable in both geometry and deformation, underscoring the heterogeneity of the MR in the patient population. There were also no consistent post-surgical global or local strain patterns between MVs. However, the pre- and post-surgical strain fields in the same MV were significantly better correlated than random pre- and post-surgical pairs (p &lt; 0.005). This quantitative result implies that the post-surgical state for each patient can be predicted from available pre-surgical data-derived modelling. Conclusions: Due to the highly variable pre-surgical state of regurgitant MVs, a patient-specific approach to MitraClip repair is crucial to improving long-term patient outcomes. Moreover, these findings suggest that the post-surgical state can be correlated to, and therefore predicted from, the pre-surgical state, which would lay the foundation for quantitative surgical planning, tailored patient selection, and ultimately, a more durable repair.